The patients who transfered to respiratory clinic from intensive care unit; prognosis and factors

Introduction: Following the critical disease, one third of deaths appear after the transfer from intensive care units to service successfully. Some deaths are seen among the patients who does not need intensive care treatment anymore and in whose clinical and physiological diagnosis there is adequate stabilization and recovery. In the patients transferred from intensive care unit to service, deaths can be caused by incomplete recovery of the primer disease or development of new complications.Purpose: In our study, our purpose is to indicate the subjects followed up through intubation and mechanical ventilation support in the intensive care unit, and the clinical course of these subjects transferred to service after removing from mechanical ventilators and to find out the factors affecting the clinical course at issue.Method: The medical records of the patients, who were followed up through intubation in the intensive care units of our hospital ( internal, anaesthesia, coronary, cardiovascular surgery, emergency intensive care) at the department of Pulmonary Disease of medical Faculty of Dokuz Eylül University (2006-2008) and were transferred to service of pulmonary diseases after this treatment, were analyzed retrospectively. From the records of data processing of our hospital, the documents relative to all patients hospitalized in the clinic of Pulmonary Diseases were obtained. Of these subjects, the ones who were transferred from intensive care units of our hospital were identified. The patient files, epicrisis and laboratory data of these subjects were scanned.Findings: Totally, 78 subjects were participated in the study. 53 of them (%67.9) from internal medicine intensive care units (internal medicine, pulmonary diseases, coronary, emergency service resuscitation unit), and 25 of them (%32.1) from the intensive care units of surgery (anasthesia, cardiovascular surgery) were transferred to service. 49 subjects (%62.8) were male, and 29 of them (%37.2) were female. While 46 subjects (%59.0) were discharged from service to home, 13 of them (%16.7) were sent back to intensive care unit due to pregression of their clinical situations. 3 subjects (%3.8), on the other hand, were followed up through intubation again in the clinic. Mortality was observed in totally 24 subjects (%30.8). 17 (%21.8) of them developed exitus in the clinic, whereas 7(%9.0) of them developed it in the intensive care units where they were sent back. Of the 24 subjects(%30.8) developed exitus, 14 of them(%28.6) were male and 10 (%34.5) were femaleThe factors observed in relation to `total mortality? both in the service and after sending back to intensive care unit were as follows: The existence of AF (p=0.001) during hospitalization of our subjects and existence of malignity (p=0.029); the use of piperacilin/tasobactam group antibiotic (p=0.007) during the hospitalization in intensive care unit; finding out AF (p=0.006) during the transfer to service and malignancy (p=0.029); the high level of D.dimer (p=0.017) during the tranfer to service;the existence of atelectasis in chest X-ray (p=0.037); the percentage of serum PNL (p=0.001); the levels of hemoglobin (p=0.001), hemotocrit (p=0.002), PT (0.016), and blood urea nitrogen (0.034); the pulse rate (0.012) and respiratory rate (0.029); the score of APACHE II (p=0.001) observed during hospitalization in intensive care unit; the score of APACHE II (p=0.001) during the transfer to service; and the score of SOFA (0.000). As a result, these were all found to be significant.On the other hand, the factors related to the mortality developed only in the service were in the following: The score of APACHE II (p=0.000) during the hospitalization in intensive care unit; the score of SOFA (p=0.018); the percentage of serum PNL(p=0.012) during the transfer to service; the levels of hemoglobin (p=0.016), hemotocrit (p=0.036), and PT (p=0.016); respiratory rate (p=0.000); the score of APACHE II skoru (p=0.000) during the hospitalization in intensive care unit; the score of SOFA (p=0.000); the existence of AF (p=0.011) and malignancy (p=0.007) during the hospitalization in intensive care unit; the existence of AF (p=0.019) and malignancy (p=0.007) during the hospitalization in service; the use of piperacilin/tasobactam group antibiotic (p=0.045) during the hospitalization in intensive care unit (p=0.045). Consequently, it was observed that all these factors were significant.Result: The scores of APACHE II and SOFA observed on the day when the subjects are taken into intensive care units and the time when they are transferred to service are the most important parameters in the estimation of mortality after discharge from intensive care units. Particularly, the score of APACHE II is more useful. In the subjects transferred from intensive care units to service, it was determined that the existence of atrial fibrillation (AF) and/or malignity led to a serious and considerable increase in mortality. In such diseases, the decision of transfer must be given more carefully and the follow-ups of the subjects must be carried out in a careful way as well. The level of D-dimer observed on the day when the subjects are transferred from intensive care units to service can be accepted as a significant parameter in predicting the prognosis of the subjects. The values over normal limits must be considered as stimulants in terms of mortality. Low hemoglobin, values of hemotocrit, long protrombin time (PT), high level of urea and the existence of atelectasis in chest X-ray can be accepted as stimulants of bad prognosis.